Flexion Chain

A dominance of the flexion chain coincides with a cranial mechanism in extension (internal rotation).

Cranium

• Occiput posterior

• Sphenobasilar synchondrosis (SBS) low

• Greater wings posterior and medial

• Peripheral bones in internal rotation

Spinal Column

Sphenobasilar Flexion

• Occipitoatlantoaxial (OAA): occiput in flexion, atlas anterior in relation.

Fig. 8.3 Flexion chain (dark blue) and extension chain Responsible muscles: rectus capitis anterior/longus (bright blue). capitis.

Note: The central tendon is also able to pull the SBS into extension. It is not a muscle, but the weight of the organs can exert a pull caudally. This is the case in this pattern because the thorax is in exhalation position and therefore cannot assist in lifting the organs.

• C3-T4: In extension, the lordosis is increased globally.

Responsible muscles: low paravertebral musculature between C3 and T4, semispinalis capitis, longissimus capitis, splenius capitis, splenius cervicis.

• T4-T12: The thoracic vertebrae are in flexion and the ribs in exhalatory position.

Responsible muscles: intercostal and abdominal muscles.

Note: It may surprise some readers that we consider the abdominal muscles as thoracic muscles. Embry-ologically, they belong to the thoracic segments from which they are also innervated (T5-L1). By their connection with the last seven ribs, they pull the thorax into flexion.

• T12-L5: The lumbar spinal column is extended. Responsible muscles: lumbar paravertebral muscles, quadratus lumborum.

Note: The continuity of the chain is preserved by the quadratus lumborum muscle, which is connected to the 12th rib and with the abdominal fascia.

• Sacrum: The sacrum makes a nutation. The basis moves forward and downward and the coccyx moves backward and downward.

Responsible muscles: multifidi muscles in the lumbosacral area.

Note: The thoracolumbar fascia is also involved in this process. Its lower leaf serves as the base for the multifidi muscles and the quadratus lumborum.

This is provided by two mechanisms:

— The gluteus maximus is connected to the tensor fasciae latae (TFL) via the iliotibial tract. The TFL prevents an external rotation of the hip. which allows the gluteus maximus to exert a pull on the ilium. The lower layer of the gluteus maximus is connected to the vastus externus, which is activated by the same motion pattern. A pull of the vastus externus in addition stabilizes the gluteus maximus.

— A rotation of the ilium backward raises the ramus of the pubis. The adductors are hereby stretched. They will reclaim the lost length on the other end, namely the femur. In a backward rotation of the ilium, the adductors pull the leg into adduction and internal rotation. This results in two positions for the lower extremity: extension + adduction + internal rotation.

• Knee: The knee is stretched. Responsible muscles: quadriceps.

• Upper ankle joint: The upper ankle joint is in plantar flexion, the talus is pressed forward between the mortise and calcaneus.

Responsible muscles: triceps surae and flexors.

• Lower ankle joint and foot: Dominance of the flexion chain results in eversion of the foot with a drop in the arch. The talus plays the main role herein. Free of muscle attachments, it is pressed forward medially by pressure from the mortise. This shifts the weight to the inner edge of the foot. The cuboid bone makes an external rotation and the navicular bone an internal rotation.

Responsible muscles: extensor digitorum longus, tibialis anterior, extensor hallucis longus, extensor digitorum longus.

Pelvic Girdle and Lower Limb

• Ilium: The ilium makes a dorsal rotation under the simultaneous pull of the abdominal and gluteal muscles.

Responsible muscles: abdominal muscles, gluteal muscles, TFL.

• Hip: The hip is extended. Responsible muscles: gluteal muscles.

Note: We have a continuous chain between the abdominal and gluteal muscles via the iliac crest on the one hand, and the quadratus lumborum and gluteal muscles via the thoracolumbar fascia on the other. For the gluteal muscles to turn the ilium dor-sally. they must be firmly supported at the femur.

Shoulder Girdle and Upper Limb

• Shoulder blade: The shoulder blade stands in abduction; the glenoid cavity is oriented forward and outward. This presents as rolled-in shoulders (Janda's upper crossed syndrome).

Responsible muscles: descending part of the trapezius, pectoralis minor.

Depending on which muscle pull dominates, the shoulder is depressed or raised.

• Upper arm: The arm is in adduction-internal rotation and extension. The pectoralis major is pulled because the thorax is in exhalatory position. It regains the lost length by moving the arm into adduction-internal rotation. The anterior shoulder exerts tension on the latissimus dorsi, which tries to regain its normal length by extending the shoulder. Responsible muscles: pectoralis major, latissimus dorsi, teres major, subscapularis.

Rectus capitis anterior, longus capitis

Peroneus muscles

Tibialis posterior

Longus colli

Thoracic paravertebrals

Rectus obliquus capitis

Quadriceps Chain

Gluteals Quadriceps

Intercostals

Quadratus lumborum, lumbar paravertebrals

■Triceps surae

Toe flexors

Abdominal muscles

-Cervical paravertebrals

Extension chain

Flexion chain a

Rectus capitis anterior, longus capitis

paravertebrals

Gluteals

Quadriceps

Triceps surae

Toe flexors

Abdominal muscles

Paravertebrals

Ischio-crurals

Ventral muscles Dorsal muscles

Ventral muscles Dorsal muscles

Ischio-crurals

Gluteals Quadriceps

Flexion chain a

Rectus capitis anterior, longus capitis

paravertebrals

Intercostals

Quadratus lumborum, lumbar paravertebrals

Quadratus lumborum, lumbar paravertebrals

Gluteals

Quadriceps

Triceps surae

Peroneus muscles

■Triceps surae

Toe flexors

Tibialis posterior

Toe flexors

Abdominal muscles

Longus colli

-Cervical paravertebrals

Abdominal muscles

Thoracic paravertebrals

Extension chain

Rectus obliquus capitis

Rectus capitis anterior, longus capitis

- Flexion chain: right half of the body

- Extension chain: left half of the body.

b Dorsal view:

- Flexion chain: right half of the body

- Extension chain: left half of the body.

• Lower arm: The elbow is flexed and the lower arm in pronation.

Responsible muscles: biceps brachii, brachialis, pronators.

• Hand: The wrist is in extension. Responsible muscles: hand extensors.

• Fingers: The fingers are flexed. Responsible muscles: finger flexors.

Here we find the reversal of flexion and extension, as well as the dominance of the extension-adduction-internal rotation aspect. Contrary to the lower extremity, where we find a global extension, however, we see a flexion here. We explain this as a remnant of archaic reflexes, as we know them from spastic hémiplégies.

Flexion chain

Rectus capitis anterior / lateral longus capitis

Cervical paravertebrals

Abdominal muscles

Quadratus lumborum / lumbar paravertebrals

Flexion chain

Rectus capitis anterior / lateral longus capitis

Abdominal muscles

Quadratus lumborum / lumbar paravertebrals

Hand

Iliopsoas extensors

Ischio-crurals

Tibialis anterior

Peroneus muscles

Short toe flexors

Gluteals Quadriceps

Adductors

Triceps surae Toe extensors

Extension chain Extension chain

Shoulder girdle and upper limb

Rectus capitis posterior, obliquus capitis

Longus Deltoid — colli Dorsal part

Rhomboids Latissimus dorsi Teres major Serratus anterior

Triceps brachii

Gluteals Quadriceps

Adductors

Triceps surae Toe extensors

[J Ventral muscles Dorsal muscles

Flexion chain Shoulder girdle and upper limb

•Trapezius Descending part

Deltoid Neutral part

Hand

Iliopsoas extensors

Finger flexors

Ischio-crurals

Tibialis anterior

Peroneus muscles

Short toe flexors

Finger flexors

Deltoid Neutral part

Biceps brachii

Hand flexors

Finger extensors

Flexor digitorum longus

Extensor digitorum longus

Extensor digitorum longus

Biceps brachii

Hand flexors

Finger extensors

Flexor digitorum longus

- Flexion chain left

- Extension chain right.

b Ventral view:

- Extension chain of the shoulder girdle and upper limb left

- Flexion chain of the shoulder girdle and upper limb right.

Flexion chain Shoulder girdle and upper limb

Trapezius

Descending part

Pectoralis major & minor

Deltoid Neutral part

Biceps brachii

Flexor muscle—M of fingers

Extension chain Shoulder girdle and upper limb

Rhomboids

-Trapezius

Horizontal and ascending part

Latissimus dorsi

Triceps brachii

Flexor carpis radialis

Flexor muscle of fingers

Flexion chain Shoulder girdle and upper limb

Pectoralis major & minor

Deltoid Neutral part

Biceps brachii

Extension chain Shoulder girdle and upper limb

Rhomboids

Latissimus dorsi

Flexor carpis radialis

Flexor muscle—M of fingers

-Trapezius

Horizontal and ascending part

J Ventral muscles Dorsal muscles

J Ventral muscles Dorsal muscles

Fig. 8.5c Dorsal view:

- Extension chain of the shoulder girdle and upper limb right

- Flexion chain of the shoulder girdle and upper limb left.

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